American Heart Association recommends prescription omega 3 to lower triglyceride levels

19 Aug 2019 --- Prescription omega 3 fatty acid medication reduces triglyceride levels by 20 to 30 percent among the majority of people who require treatment for high levels of these fats, which elevate heart disease risk. This is according to a science advisory from the American Heart Association (AHA). The researchers advise that high triglyceride levels should not be treated with non-prescription, non-FDA-regulated omega 3 fatty acid fish oil supplements. AHA underscores a lack of scientific research to support clinical use of omega 3 supplements to prevent heart disease in the general population.

Triglycerides are fats that circulate in the blood. Some studies have shown that elevated levels of triglycerides (above 200 mg/dL) can lead to atherosclerosis (narrowing of the arteries), which increases the risk of heart attacks and strokes. In addition to cardiovascular risk, very high levels of triglycerides (above 500 mg/dL) can also cause pancreatitis, an inflammation of the pancreas.

“From our review of the evidence from 17 randomized, controlled clinical trials on high triglyceride levels, we concluded that treatment with 4 grams daily of any of the available prescription choices is effective and can be used safely in conjunction with statin medicines that lower cholesterol,” says Ann Skulas-Ray, Ph.D., an author of the new science advisory published in the AHA journal Circulation.

There are currently two prescription omega 3 fatty acid medications available, the researchers note. One combines two types of fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). The other medication provides EPA only. Since there have been no head-to-head comparisons of the two different formulations at prescription dosing, the advisory does not recommend one over the other.

Elevated triglycerides are relatively common among people in the US, and the prevalence is increasing due to growing rates of obesity and diabetes. Both of those conditions raise triglyceride levels. About 25 percent of adults in the US have a triglyceride level above 150 mg/dL, which is considered borderline high.

The researchers advise not to treat high triglyceride levels with non-prescription omega 3 fatty acid fish oil supplements.Omega 3 medication vs. supplementation
Skulas-Ray points out that people with high triglyceride levels should not try to treat the condition themselves with non-prescription, omega 3 fatty acid fish oil supplements.

“Dietary supplements containing omega 3 fatty acids are not regulated by the US Food and Drug Administration(FDA). They should not be used in place of prescription medication for the long-term management of high triglycerides,” she explains. 

In a 2017 science advisory, AHA noted that there is a lack of scientific research to support the clinical use of omega 3 fatty acid supplements to prevent heart disease in the general population. In July 2018, UK-based medical research charity Cochrane proposed that consuming additional omega 3 fatty acids, compared to usual or lower omega 3, has little to no effect on the risk for cardiovascular events, coronary heart deaths, coronary heart disease events, stroke or heart irregularities.

Study pinpoints the ideal dose of omega 3
The effective dose for prescription omega 3 fatty acids is four grams per day taken with food, according to the researchers at the AHA. Currently, the FDA has approved prescription omega 3 fatty acid medications only for treating very high triglyceride levels above 500 mg/dL.

Healthy lifestyle choices, such as getting regular physical activity, losing weight, avoiding sugar and refined carbohydrates and limiting alcohol, as well as choosing healthier fats from plants in place of saturated fats can further help reduce triglycerides. 

The researchers also highlight that it is important to treat or eliminate conditions such as poorly controlled Type 2 diabetes, hypothyroidism and obesity that may contribute to high triglyceride levels before turning to medication.

Fish is a good source of omega 3 fatty acids, and AHA recommends eating fatty fish – such as salmon, mackerel, herring and albacore tuna – at least two times per week.

In analyzing the current scientific data, the advisory panel additionally found:

For most people with high triglycerides, prescription doses of omega 3 fatty acids using drugs with either EPA+DHA or EPA alone can reduce triglycerides by 20 to 30 percent.

Contrary to common perception, the formula that contains both EPA and DHA does not increase the “bad” form of cholesterol (LDL-C) among most people with high triglyceride levels. However, when the drug is given to people with very high triglyceride levels, LDL-C may increase.

The panel's review found that the prescription omega 3 drugs are effective in reducing triglyceride levels regardless of whether people are on statin therapy.

In a recent large, randomized placebo-controlled study called REDUCE-IT, researchers found that the EPA-only medication combined with statin medication resulted in a 25 percent reduction in major cardiovascular events (heart attack, stroke and cardiovascular death) among people with high triglycerides.

By Benjamin Ferrer